BACKGROUND.Patients with advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) have a particularly grave prognosis. In the current study, an attempt was made to localize chemoradiation therapy (CCRT) followed by hepatic arterial infusion chemotherapy (HAIC) in patients with locally advanced HCC with PVT and good reserve liver function. The objective of the current study was to evaluate the therapeutic effect of localized CCRT followed by HAIC as a new treatment modality for these patients.METHODS.Between January 1998 and December 2003, 40 patients were recruited. Concurrent regional chemotherapy using an intra‐arterial implanted port plus localized external beam radiotherapy was performed with a total of 45 gray (Gy) over 5 weeks with conventional fractionation and hepatic arterial infusion of 5‐fluorouracil (5‐FU), which was administered during the first and fifth weeks of radiotherapy. One month after localized CCRT, HAIC with 5‐FU and cisplatin was administered every 4 weeks.RESULTS.One month after localized CCRT, an objective response was observed on the intention‐to‐treat analysis in 18 of 40 patients (45%). The actuarial 3‐year overall survival rate was 24.1% and the median survival time was 13.1 months from the start of radiation treatment. Responders after localized CCRT demonstrated significantly better survival (P = .033) than nonresponders.CONCLUSIONS.The substantial response rate as well as median survival time noted in the current study encourages the use of this new approach in patients with locally advanced HCC with PVT. Cancer 2008. © 2008 American Cancer Society.

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Intravascular US and manometric findings clarify the mechanisms of branch-vessel compromise after aortic dissection and provide a rational guide for percutaneous treatment.

BACKGROUND. Hepatic arterial infusion chemotherapy (HAIC) has often been selected as a therapeutic option for patients with advanced hepatocellular carcinoma (HCC). The objective of the current study was to evaluate the efficacy and safety of repetitive HAIC with high‐dose 5‐fluorouracil (5‐FU) and cisplatin given for 3 days in patients with advanced HCC. METHODS. Between January 2001 and December 2004, a total of 41 patients with unresectable advanced HCC were enrolled. The patients underwent HAIC via the implantable port system with 5‐FU (at a dose of 500 mg/m2 on Days 1–3) and cisplatin (at a dose of 60 mg/m2 on Day 2) every 4 weeks. Tumor response was assessed at the end of every 3 cycles. RESULTS. The median age of the patients was 53 years and 34 patients (82.9%) had evidence of portal vein thrombosis. In total, 230 cycles of HAIC were administered to the 41 patients, with a median of 6 cycles given (range, 1–14 cycles). Nine patients (22.0%) achieved a partial response and 14 patients (34.1%) had stable disease. The median time to disease progression and overall survival were 7.0 months and 12.0 months, respectively. The overall survival was found to be significantly longer in the successful disease control group (patients with a complete response, partial response, and stable disease) than in the disease progression group (median of 14.0 months vs 6.0 months; P < .001). Adverse reactions were tolerable and successfully managed with conservative treatment. CONCLUSIONS. HAIC with high‐dose 5‐FU and cisplatin given for 3 days achieved effective and safe results in patients with advanced HCC. Therefore, repetitive short‐course HAIC with high‐dose 5‐FU and cisplatin may be useful as an alternative therapeutic option for patients with advanced HCC. Cancer 2007. © 2007 American Cancer Society.

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